Article Title and Bibliographic Information Alhafi et al. Quality and stability of orthodontic treatment outcomes with clear aligners versus fixed appliances. Eur J Orthod. 2025;47:cjaf091. Source of Funding None reported. Type of Study/Design Systematic review with meta-analysis of data.
Subjects or Study Selection Eighteen in vivo diagnostic accuracy studies involving 1,300 participants and 25,757 teeth were included. Eligible studies evaluated visual detection of primary or secondary dental caries using clinical photographs and compared the findings with visual clinical intraoral examination as the reference standard. Studies reporting sufficient data to calculate diagnostic accuracy measures were included. Key Study Factor Visual assessment of dental caries using clinical photographs obtained with smartphones, intraoral cameras, or DSLR cameras was compared with visual clinical intraoral examination. Diagnostic performance was evaluated across different diagnostic thresholds, dentition types, photographic technologies, and photographer backgrounds. Main Outcome Measure The primary outcome was the diagnostic accuracy of visual assessment using clinical photographs for detecting dental caries compared with visual clinical intraoral examination, expressed primarily as pooled sensitivity and specificity across enamel caries, dentine caries, and any caries depth. Main Results Visual assessment of clinical photographs demonstrated clinically acceptable diagnostic accuracy for detecting dental caries, with pooled specificity consistently ranging from 0.95 to 0.99 across diagnostic thresholds and pooled sensitivity ranging from 0.74 to 0.81. No statistically significant differences were identified according to diagnostic threshold, dentition, photographic technology, or photographer. Conclusions The authors concluded that visual assessment of clinical photographs demonstrated clinically acceptable accuracy for detecting dental caries when compared with visual clinical intraoral examination. The consistently high specificity suggests that clinical photography is useful for identifying sound tooth structure and may facilitate clinical decision-making.
Subjects or study selection The authors searched PubMed/MEDLINE, Scopus, Web of Science, LILACS, and the Cochrane Library for systematic reviews published in English between January 2000 and December 2025. Eligible reviews evaluated human patients receiving dental implants placed using osseodensification or conventional drilling and reported at least one prespecified outcome. From 780 records, nine systematic reviews were included. These incorporated randomized and nonrandomized clinical studies, principally involving posterior maxillary or other low-density bone sites. The methodological confidence of the reviews was rated using AMSTAR 2: five were moderate, two low, and two critically low; none achieved high confidence. Key study factor The intervention was implant osteotomy preparation using specialized osseodensification burs operated in a noncutting, counterclockwise direction to compact bone laterally within the osteotomy. The comparison was conventional subtractive drilling, in which rotating drills remove bone to prepare the implant site. Main outcome measure The single outcome was primary implant stability measured by implant stability quotient (ISQ) using resonance frequency analysis. Measurements were obtained at implant placement or during early postoperative follow-up, although measurement timing and protocols differed among the underlying studies. Main results Most included reviews reported higher ISQ values after osseodensification, particularly in low-density bone. However, the umbrella review did not generate an overall pooled estimate. Yu and colleagues reported a mean difference of 10.25 ISQ units favoring osseodensification (95% confidence interval, 4.97–15.52; P<.001). Monteiro and colleagues reported a median difference of 8.57 units, whereas Shilpi and colleagues reported a nonsignificant standardized mean difference of 2.13 (95% confidence interval, −0.08 to 4.35; P=.06). Interpretation was limited by heterogeneous measurement protocols, differences in implant systems and surgical sites, methodological weaknesses within the reviews, and moderate overlap of primary studies across reviews. The corrected covered area was 7%. Conclusions The authors concluded that osseodensification is associated with higher ISQ values than conventional drilling, particularly in low-density bone. They emphasized that the observed improvement represents a surrogate measure of primary stability and that its long-term clinical importance remains uncertain.
Subjects or study selectionThe authors searched PubMed/MEDLINE, Web of Science, and Google Scholar for English-language human studies published from 2010 through 2024. Randomized (RCT) and nonrandomized controlled studies (nRCT) comparing osseodensification with conventional drilling and reporting implant stability or bone density were eligible. Of 1,454 records, six studies were included: one RCT and five nRCTs. These comprised 116 participants and 250 implants. Implant sites included the anterior and posterior maxilla and posterior mandible. Five studies contributed data to the immediate implant stability quotient (ISQ) meta-analysis. The RCT was judged to have a high overall risk of bias. Four nRCTs had a serious risk of bias, whereas one was rated as having low risk.Key study factorThe intervention was implant-site preparation with specialized osseodensification burs used in a counterclockwise, noncutting direction to compact bone against the osteotomy walls. The comparison was conventional subtractive drilling, in which rotating drills remove bone during osteotomy preparation.Main outcome measureThe single outcome was primary implant stability measured immediately after implant placement using ISQ derived from resonance frequency analysis. Higher ISQ values indicate greater implant-bone interfacial stiffness but do not directly measure osseointegration or clinical success.Main resultsFive studies were included in the immediate ISQ meta-analysis. The forest plot reported 125 implant-level observations in each group. Osseodensification produced a numerically higher ISQ, but the difference was not statistically significant: standardized mean difference, 2.13; 95% confidence interval (CI), −0.08 to 4.35; P=.06. Statistical heterogeneity was extreme: I2=97%, Tau2=6.14, and Cochran Q (reported as χ²)=130.10, with 4 degrees of freedom (P<.00001). The CI encompassed no effect, and the magnitude of the individual study estimates varied markedly.ConclusionsThe authors concluded that implants placed using osseodensification demonstrated greater stability in low-density bone than implants placed with conventional drilling, while acknowledging the need for additional clinical research. This conclusion is more affirmative than the quantitative result supports because the pooled difference was nonsignificant, highly heterogeneous, and derived mainly from nonrandomized evidence at serious risk of bias.PURPOSE/QUESTIONIn adults receiving endosseous dental implants in sites described as having low bone density (P), does osteotomy preparation with osseodensification burs (I), compared with conventional subtractive drilling (C), improve primary implant stability measured by implant stability quotient immediately after placement (O)?
